Atlantic health release of information 2026

1. Click ‘Get Form’ to open the Atlantic Health Release of Information in the editor.
2. Fill in today’s date, patient information including name, date of birth, medical record number, address, and daytime phone number.
3. Select the Atlantic Health System facility where treatment occurred by checking the appropriate box.
4. Provide the recipient's name and address. If the recipient is the same as the patient, check the corresponding box.
5. Indicate the purpose for requesting records by checking one of the options provided.
6. Choose your preferred delivery method for receiving records: paper copy, electronic media, fax, etc., and provide necessary details.
7. In Section B, if applicable, authorize Atlantic Health System to obtain records from another facility by filling in their details.
8. In Section C, specify what information you wish to be released by checking relevant boxes or writing in specific requests.
9. Sign and date Section D to authorize this request. Ensure all required signatures are included if a representative is signing.

Start using our platform today for free to streamline your document editing and signing process!